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#18-002071-0011
Supplemental Questionnaire

Last Name
First Name

 

***Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit.***


1.

Describe your experience planning, developing, implementing and promoting health education projects within an oral health setting. This experience should also be included in your application. If you do not possess this type of experience, indicate N/A in the text box below.

2.

Do you possess a Master's degree from an accredited college or university in Public Health Education, Community Health Education or Health Science?

Yes No
3.

Do you possess a Bachelor’s degree from an accredited college or university in Public Health Education, Community Health Education or Health Science?

Yes No
4.

If you do not have a Bachelor's degree in Public Health Education, Community Health Education, or Health Science, do you have a minimum of 18 credits hours in Public Health Education, Community Health Education, Health Science, or a related behavioral science? 

If you answered "yes" to this question, a copy of your transcripts (official or unofficial) must be submitted with your application to receive credit. 

Yes No
5.

Do you possess a Doctorate in Public Health, Community Health Education, Health Science or Public Health Policy?

Yes No

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